Platelet Function Changes as Monitored by Cone and Plate(let) Analyzer during Beating Heart Surgery
Background: Off-pump coronary artery bypass (OPCAB) is believed to reduce cardiopulmonary bypass (CPB)-related complications, including platelet damage. A hypercoagulable state instead of coagulopathy has been reported following OPCAB surgeries due to CPB. Whether platelet function is changed when the injurious effect of CPB is eliminated was investigated.
Methods: Platelet function was determined with the cone and plate(let) analyzer (CPA) method. The 2 parameters, average size (AS) and surface coverage (SC) of platelet aggregates, were measured with the CPA method to assess platelet aggregation and adhesion. These parameters were evaluated, and their values were compared at several stages of OPCAB surgery. The correlations of postoperative bleeding with platelet function at different stages of the surgery and with other factors, such as platelet count, hematocrit, and transfusions, were studied.
Results: Both AS and SC increased during several stages of the operation, and postoperative values (mean ± SD) were significantly higher than preoperative values (30.4 ± 8.1 m m2 versus 23.3 ± 6.9 m m2 for AS [P = .02] and 7.6% ± 3.6% versus 5.2% ± 1.8% for SC [P = .04]). The mean total bleeding volume was 875 ± 415 mL. Preoperative AS and SC were the only parameters significantly (P = .01) and linearly (r = 0.7) related to postoperative bleeding.
Conclusions: An increased platelet function, as determined by the CPA method, is found following OPCAB surgery. This phenomenon is probably at least partially responsible for the thrombogenic state after OPCAB surgery. Lack of platelet injury attributed to CPB may divert the system toward a more thrombogenic state. Preoperative platelet function, as evaluated by the CPA method, is an independent risk factor determining postoperative bleeding.
Ascione R, Williams S, Lloyd CT, Sundaramoorthi T, Pitsis AA, Angelini SD. 2001. Reduced postoperative blood loss and transfusion requirement after beating heart coronary operations: a prospective randomized study. J Thorac Cardiovasc Surg 121:689-96.nCartier R, Robitaille D. 2001. Thrombotic complications in beating heart operations. J Thorac Cardiovasc Surg 121:920-2.nChandrasekar B, Tanguay JF. 2000. Platelets and restenosis. J Am Coll Cardiol 35:555-62.nColler BS. 1998. Monitoring platelet GP IIb/IIIa antagonist therapy. Circulation 97:5-9.nCollman RW. 1990. Platelet and neutrophil activation in cardiopulmonary bypass. Ann Thorac Surg 49:32-4.nDespotis GJ, Gravlee G, Filos K, Levy J. 1999. Anticoagulation monitoring during cardiac surgery: a review of current and emerging techniques. Anesthesiology 91:1122-51.nFalciani M, Gori AM, Fedi S, et al. 1998. Elevated tissue factor and tissue factor pathway inhibitor circulating levels in ischaemic heart disease. Thromb Haemost 79:495-9.nKaboli P, Henderson MC, White RH. 2003. DVT prophylaxis and anticoagulation in the surgical patient. Med Clin North Am 87:77-110.nKenet G, Lubetsky A, Shenkman B, et al. 1998. Cone and platelet analyser (CPA): a new test for the prediction of bleeding among thrombocytopenic patients. Br J Haematol 101:255-9.nKroegel C, Reissig A. 2003. Principle mechanisms underlying venous thromboembolism: epidemiology, risk factors, pathophysiology and pathogenesis. Respiration 70:7-30.nLasne D, Fiemeyer A, Chatellier G, Chammas C, Baron JF, Aiach M. 2000. A study of platelet functions with a new analyzer using high shear stress (PFA 100) in patients undergoing coronary artery bypass graft. Thromb Haemost 84:794-9.nLevy JH, Smith PK. 2000. Platelet inhibitors and cardiac surgery. Ann Thorac Surg 70(suppl):S1-2.nMariani MA, Gu YJ, Boonstra PW, Grandjean JG, van Oeveren W, Ebels T. 1999. Procoagulant activity after off-pump coronary operation: is the current anticoagulation adequate? Ann Thorac Surg 67:1370-5.nQuigley RL, Fried DW, Salenger R, Pym J, Highbloom RY. 2002. Thrombelastographic changes in OPCAB surgical patients. Perfusion 17:363-7.nShenkman B, Inbal A, Tamarin I, Lubetsky A, Savion N, Varon D. 2003. Diagnosis of thrombotic thrombocytopenic purpura based on modulation by patient plasma of normal platelet adhesion under flow condition. Br J Haematol 120:597-604.nShenkman B, Schneiderman J, Tamarin I, Kotev-Emeth S, Savion N, Varon D. 2001. Monitoring GPIIb-IIIa antagonist therapy in patients undergoing carotid stenting: correlation between standard aggregometry, flow cytometry and the cone and plate(let) analyzer (CPA) methods. Thromb Res 102:311-7.nvan Dijk D, Nierich AP, Jansen EW, et al. 2001. Early outcome after off-pump versus on-pump coronary bypass surgery. Circulation 104:1761-6.nStahl RF, Vander Salm TJ. 1996. Early postoperative care. In: Edmunds LH Jr, editor. Cardiac surgery in the adult. Columbus, Ohio: McGraw-Hill.nVaron D, Lashevski I, Brenner B, et al. 1998. Cone and plate(let) analyzer: monitoring glycoprotein IIb/IIIa antagonists and von Willebrand disease replacement therapy by testing platelet deposition under flow conditions. Am Heart J 135:S187-93.nWan S, LeClerc JL, Vincent JL. 1997. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies. Chest 112:676-92.nWeerasinghe A, Taylor KM. 1998. The platelets in cardiopulmonary bypass. Ann Thorac Surg 66:2145-52.n